End of life choices.
Subject: Terminal care (Planning)
Advance directives (Medicine) (Usage)
Author: Collins, Angela Smith
Pub Date: 09/22/2010
Publication: Name: Online Journal of Rural Nursing & Health Care Publisher: Rural Nurse Organization Audience: Academic Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2010 Rural Nurse Organization ISSN: 1539-3399
Issue: Date: Fall, 2010 Source Volume: 10 Source Issue: 2
Topic: Event Code: 220 Strategy & planning Computer Subject: Company business planning
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 245393196
Full Text: Do you have an advanced directive? This question is asked by healthcare personnel in countless healthcare settings each day. Most healthcare providers acknowledge the importance of advance directives when choosing treatment plans of patients especially at the end of life. However, advance directives are often not approached in patient care planning except in times of a critical illness or futile care. Thinking about the process of dying is difficult for many people. The healthcare environment is a mystery to the majority of our patients and the role played as a translator is vital to informed healthcare decisions. What actions can you take to increase awareness of this problem in your community of concern?

* Advocacy about end of life decisions is a role that every healthcare provider can play. Sharing our own wishes with our family members is a good place to begin the dialogue relevant to end of life choices.

* The important aspect is to simply listen and provide resources. The Robert Wood Johnson foundation keeps an updated set of resources and research relevant to end of life care on their website http://www.rwjf.org/pr/topic.jsp?topicid=1194 and offers extensive continuing education on this topic.

* Work within your professional organization to offer educational offerings in your community regarding the services of hospice and palliative care.

Self determination for which treatments are desired at the end of life is a personal decision but the impact on healthcare dollars is extensive. Annually, Medicare spends thirty percent of their budget on the five percent of beneficiaries who will die in a given year. The greatest concentration of these expenditures is in the last month of life (NHPCO, 2009). Due to diminishing resources and increasing numbers of frail elderly tough decisions will be forced. It is vital that healthcare providers assist patients and families to determine the quality of both their life and death.


National Hospice and Palliative Care Organization. (2009). Discussions about end-of-life care reduce health costs in last week of life. Retrieved November 5, 2010, from http://www.nhpco.org/i4a/pages/Index.cfm?pageID=5850

Angela Smith Collins, RN, DSN, ACNS, BC, CCNS

Editorial Board Member
Gale Copyright: Copyright 2010 Gale, Cengage Learning. All rights reserved.